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Surgeons worked all day and into the night to ensure Britain’s first womb transplant went smoothly. Its success is down to meticulous research, years of sharing knowledge between experts around the globe, and the hard work and dedication of doctors Professor Richard Smith, from Imperial College London, and Isabel Quiroga, from the Oxford Transplant Centre. Around 50 babies have been born worldwide as a result of womb transplants, which give women missing a functioning uterus a chance to have a baby. In the first UK case, the operation to remove the womb from the recipient’s 40-year-old sister lasted eight hours and 12 minutes, with surgeons leaving her ovaries behind to prevent pushing her into early menopause. One hour earlier, surgeons began operating on the 34-year-old recipient, preparing her body to receive the donated organ. This operation lasted nine hours and 20 minutes, with the surgical team experiencing some difficulties including a higher-than-expected blood loss of two litres. However, after just 10 days, the recipient was well enough to leave the hospital and has continued to have a good recovery. She is also having regular periods, which shows the womb is working well. Her sister was discharged five days after her donor operation and has also made a good recovery. Removing a womb is a similar operation to a radical hysterectomy, according to Prof Smith, who as well as being a gynaecological surgeon is the clinical lead at the charity Womb Transplant UK. He and Miss Quiroga led the team of more than 30 staff who worked on the transplant one Sunday in February. Prof Smith and Miss Quiroga removed the older sister’s womb, cervix and fallopian tubes, plus crucial blood vessels around the organ. The main vessels are the uterine arteries running into the womb, but the surgeons also aimed to collect some of the larger internal vessels that lead into the smaller branch of the womb. Prof Smith said surgeons doing these operations have to retrieve veins involved in the drainage of the womb. “One of the amazing things is that my surgical skill-mix as a cancer surgeon is to remove organs with a margin of normal tissue, while sealing the vessels as I go,” he said. “Transplant surgical skills are different – that is to remove a normal organ with the best number of non-sealed vessels as you can. “Isabel and I operate together with no ego – it just flows backwards and forwards across the table.” He added: “The day itself was truly humbling. We turned up at 7am at the Churchill transplant centre with the donor and the recipient families, then we went into a pre-op huddle. Those in the huddle included surgeons, nurses, anaesthetists and technicians. Prof Smith and Miss Quiroga worked to remove the womb, before the organ was prepared for transplantation by a “back table” team. “This was an organ which had a very, very unusual blood supply,” Prof Smith said. “In fact, it had a set of blood vessels which I’ve never seen in my entire career. They made my dissection a bit harder than it might have been, but we got there.” In the theatre next door, one hour before the retrieval of the womb was completed, surgeons began to operate on the donor’s younger sister to enable her to receive the womb. Prof Smith and Miss Quiroga switched from donor to recipient and Prof Smith removed the vestiges of the underdeveloped womb the recipient was born with. Meanwhile, the organ was packed and transported between the two theatres under sterile conditions to prevent contamination. A sterile bag with a cold perfusion solution contained the womb, which was then placed into a container with ice. During surgery, ligaments attached to the womb were attached to the recipient to help the womb stay in a relatively fixed place so it does not move around the pelvis. The most important part of the transplant operation was the joining of the very small vessels that give the blood supply to the womb. This was the most delicate and difficult part of the operation and was led by Miss Quiroga. Once all the vessels were connected, the donor’s vaginal cuff – around a 1cm part – was stitched into her sister’s vagina. If and when the recipient is able to complete her family, the womb will be removed six months later to prevent her from needing immunosuppressants for the rest of her life. Prof Smith said: “We know that the chance of failure at the point where the uterus goes in – if you look at the world literature – is 20 per cent to 25 per cent. And that failure is usually on the basis on sepsis and thrombosis. So technically, we are up to the job, but what happens thereafter can be scary. “Once you get to three or four days later, the chance of failure drops to probably less than 10 per cent. “Once you get to two weeks – and at the point where the woman has a period – the chance of her having a baby at that point is very high and the chance of failure has dropped to low. But those first two weeks – it’s very scary as a surgeon to watch and wait.” Biopsies to check the womb was functioning were read in London but then also confirmed by an expert team in the US at Baylor University Medical Centre in Dallas, where other womb transplants have been performed. Prof Smith said the procedure gives new hope to women born with devastating conditions. He said: “You’ve got girls, maybe 14, who have not had periods, they go to the GP and a scan shows there is no uterus. Absolute catastrophe. “Up until now, there’s been no solution for that, other than adoption or surrogacy... That’s not the case now. It’s really exciting.” On whether transgender women may also benefit from the operation, Prof Smith said that was still a long way off. He said the pelvic anatomy, vascular anatomy and shape of the pelvis are different, and there are microbiome issues to overcome. “My own sense is if there are transgender transplants that are going to take place, they are many years off. There are an awful lot of steps to go through. My suspicion is a minimum of 10 to 20 years.” Miss Quiroga said the living donor programme to date in the UK has focused on women with relatives who are willing to give their wombs. “It will come to a point where we will have friends or altruistic donors, like we have with many other transplants, but at the moment we’re only focused on people who have come forward with relatives,” she said. 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More and more men are embracing statement jewellery and wearing engagement rings, according to industry insiders. The trend isn’t exactly brand new. For example, back in 2009, American singer, actress and TV host Jennifer Hudson decided to propose back to her then partner, American actor David Otunga – getting down on one knee with a ring in hand, five months after he’d first popped the question to her on her 27th birthday. Later, singer Michael Bublé sported an engagement ring after he and Luisana Loreley Lopilato de la Torre got engaged, telling fans it was usual that “the boy also wears the engagement ring” in Argentina, where his now wife is from. Former American footballer Osi Umenyiora was another male celeb spotted wearing an engagement ring, among others. Attitudes are shifting For Arabel Lebrusan, founder and designer at ethical jewellery designer brand Lebrusan Studio, the margins for ‘bridal’ jewellery customs are shifting, largely in line with our evolving understanding of gender roles and identity. “But what makes the current demand difficult to define by concrete statistics is the difference in the language used to refer to engagement rings for men versus engagement rings for women, with men’s engagement rings often discussed in more ambiguous terms,” Lebrusan told PA Media.“Western tradition has assigned engagement rings primarily to women for centuries, but a greater emphasis on gender equality within couples and increasing visibility, inclusivity and liberty of LGBTQ+ people has loosened the rules that once governed who could and couldn’t wear an engagement ring,” she added.“Up until last year, we’d never knowingly been commissioned to create a men’s engagement ring, so even one assignment in this field is technically an increase.” What should you look for in a men’s engagement ring? According to the industry experts, male engagement rings are usually selected on an individual basis and every enquiry is different. Dan Dower, design director at Dower & Hall, said they rarely get asked for an actual engagement ring for men – it tends to be a more elaborate or stone set ‘wedding’ ring, which does the job, and often in white gold or platinum. “We’ve done quite a few with diamonds, but also with other stones like sapphires and even one recently set with a faceted labradorite. It was definitely a statement engagement ring, which was then reconfirmed as the wedding ring,” explained Dower. “We’ve had commissions from both gay and straight men – but all definitely super confident in their tastes and appearance, which has been a joy to work with.” Do men have separate engagement and wedding rings? Traditionally, women have tended to have an engagement ring at the point of proposal, and then a different wedding ring once married. Is it the same for men who choose to wear an engagement ring? “More often, the ‘engagement’ ring then becomes the ‘wedding’ ring,” said Dower. “Or we might do a ‘commitment’ ring, which is worn on a different finger or right hand, followed by a ‘wedding’ ring for the ring finger.” Ultimately, it’s an individual choice and traditions don’t need to dictate how you choose to do things! How much do men’s engagement rings cost? Cost often depends on a number of factors, including how complex the design is and the materials used. Simple bands without any gemstones will cost less than more detailed rings, of course. Pricing can typically start anywhere from £200 to £2,000. What are the things to be mindful of? Lebrusan strongly encourages men to think about the materials they go for, since they will be wearing the engagement ring every day, and maybe for years on end. She suggests: “Choosing only from a pool of resilient metal and gemstone options – think platinum, 18ct gold, diamond or sapphire. For those with bigger hands, we also recommend considering chunkier styles, since incredibly slender bands can be compromised by large internal diameters. “Jewellery care requirements vary depending on style and materials, so it’s worth asking your jeweller for some detailed tips for caring for your engagement ring before you part ways,” Lebrusan added. “As a general rule of thumb, however, any engagement ring should be easily removed before any form of sport, housework or manual labour.” Read More Charity boss speaks out over ‘traumatic’ encounter with royal aide Ukraine war’s heaviest fight rages in east - follow live 11 ways to work the terracotta trend 3 great abs exercises that aren’t crunches ‘Women short-changed as 65% of weekly working hours ignored in official data’